In many parts of rural India, when a baby is born, there is an engrained belief that the first breast milk – the vital colostrum, that is power packed with nutrients and acts as a natural boost to a baby’s immune system – maybe indigestible or may harm the baby!  And sometimes due to lack of awareness of nipple care, mothers are also not ready to start with breastfeeding.

But on the contrary, India’s National Guidelines on Infant and Young Child Feeding, along with the WHO, highlight the importance of ‘breastfeeding within the first 1 hour of birth’ to give a baby, and its breastfeeding journey, the best start in life, and not only continue till 6 months of age but also support  it along with complementary feeding upto 2 years of age.

In India effective implementation of recommended infant feeding practices is yet to be achieved.  According to the  estimates by the National Family Health Survey (NFHS-5) only 41% children were breastfed within the first 1 hour of birth and in rural areas its only 40%.

Despite widespread knowledge and a culture that breastfeeding is vital to supporting growth rates of babies, which is maximum in their first year of life, infant feeding practices (both breastfeeding and complementary feeding), which have a major role in determining the nutritional status of a child later in life, leave much to be desired in a rural context.

As a country saddled with a heavy burden of malnutrition, this warrants our attention. Breastfeeding is the fundamental right of each and every child. Early initiation of breastfeeding within one hour and exclusive breastfeeding for first 6 months are identified as key interventions to achieve SDGs, related to child malnutrition and mortality respectively.

Breastfeeding & Malnutrition

The link between infant feeding and malnutrition has been well established.  Recent UNICEF’s evidence reveals that malnutrition has been responsible, both directly and indirectly, for 60% of deaths among under 5 year old children, annually – with over two thirds of these, associated with inappropriate feeding practices that occurred during the first year of life. 

Only 35% of infants worldwide are exclusively breastfed during the first four months of life and complementary feeding begins either too early, or too late, with foods which are often nutritionally inadequate and unsafe.  Poor feeding practices in infancy and early childhood, resulting in malnutrition, contribute to impaired cognitive and social development, poor school performance, and reduced productivity in later life.  And are therefore a major threat to social and economic development as they are among the most serious obstacles to attaining and maintaining the health of this important, vulnerable age group.

Rural Realities - On Ground

But in a complex country like India, breastfeeding in rural areas is all too often shaped by the beliefs of a community, which are further influenced by social, cultural, and economic factors. 

Most mothers in the villages, driven by necessity to get back to agricultural or labour work, entrust their little ones to elderly in-laws or parents – interrupting the regularity of breastfeeding and introducing complementary feeding too soon. And sometimes the ratio of breastfeeding & complementary feeding are imbalanced even for children upto 2 years of age which invites Malnutrition. Worse still, some mothers who don’t have support systems at home or when work is at its peak, are forced to carry their infants to the fields where they work, exposing them to potential infections and sometimes neglect.

So, with the dire need for family incomes, a lack of support or access to information, and changing societal norms, breastfeeding can all too often take a back seat in a rural woman’s life - leading to a loss of the many advantages that breast milk offers infants.

Breast milk is a natural, nutrient-rich source of nourishment for newborns, tailored to meet their specific needs and development. It provides essential vitamins, minerals, antibodies, and enzymes, bolstering their immune systems and protecting them against various illnesses. Breastfeeding is associated with a reduced risk of infections, allergies, asthma, and sudden infant death syndrome (SIDS), among other health benefits. Furthermore, the act of breastfeeding fosters a unique bond between mother and child, enhancing emotional connections and building a sense of security

But appropriate breastfeeding practices depend on accurate information and support from the family, community, and healthcare system – sometimes difficult to find in rural India.

Importance of Antenatal & Prenatal Care

It is for these reasons, that ACF through their Sakhis (community health volunteers) specifically targets expectant and new mothers on a monthly basis during their Antenatal Care (ANC) and Postnatal Care (PNC) phases specifically making them aware of the nutrition and care to be taken. These interventions address common misconceptions and challenges faced by mothers and involves educating young couples about the essential ways of breastfeeding, proper breastfeeding techniques, and the prevention of infections and illnesses. By addressing misconceptions and providing essential knowledge, ACF empowers mothers to provide their infants with the best possible start in life.

Some of the key initiative by ACF include:

·       Awareness & Guidance: ACF makes mothers aware of the importance of not skipping breastfeeding sessions and provides them with guidance on how to manage their work and childcare responsibilities effectively.

·       Training: During the last trimester, Sakhis also emphasize on nipplecare and its importance with measures to be practiced just a few days before delivery. Sakhis also train them on crawling methods which is of high importance of early and exclusive breastfeeding. This helps mothers to be mentally prepared and ready after delivery

·       Maternal Benefit Schemes: ACF introduces mothers to maternal benefit schemes that offer incentives for important milestones like childbirth, child vaccination, and reaching six months of age. This helps balance the loss of income and enables the purchase of essential nutrition supplements for the child.

·       Diarrhoea Management Centres: ACF provide referrals to diarrhoea management centres in each block, where children diagnosed with diarrhoea can receive treatment. The mother stays with the child during this period for proper and supportive treatment of the child.

·       Home Visits & Support: ACF's team, including Sakhis, and Anganwadi workers, conduct home visits to monitor the child's health and provide advice to secondary caretakers on proper childcare practices.

·       MAA Program : Recognizing the need to encourage young mothers to take breastfeeding seriously, the government has initiated the MAA (Mother’s Absolute Affection) program, which aims to strengthen the bond between mother and child and undilutedly focus on promotion of breastfeeding. Complementing the MAA program, the Sakhis are further reaching out to pregnant & lactating mothers with the appropriate govt. provided guidelines.

Through these interventions, ACF is making a significant impact in supporting new mothers and ensuring that their infants receive the essential nutrition they need for healthy growth and development. ACF’s maternal child health program has seen improvements to critical indicators by providing Antenatal Care services to over 3000 women and also reached over 10,000 children through the malnutrition program.

But there is much work left to be done. Despite much progress, there is a continued need to focus on maternal and new born care, with a focus on promoting proper breastfeeding practices and infant nutrition. As so many other social issues vie for our attention these days, it is vital that we do not forget the importance of this, given the crucial role it plays in ensuring quality health and nutrition for the next generation.